临床误诊为黑素瘤的其他疾病141例分析

Analysis of 141 cases clinically misdiagnosed as melanoma

目的分析141例临床误诊为黑素瘤的病例,提高疾病认识及诊断水平。方法回顾分析第四军医大学西京皮肤医院2001年11月至2019年9月病理数据库中141例临床初诊为黑素瘤但经组织病理检查排除黑素瘤诊断的患者临床及组织病理资料。结果误诊为皮肤黑素瘤141例,男64例,女77例,误诊时中位年龄51岁,平均病期103.4个月。皮损主要表现为斑片、丘疹,颜色以黑色为主,组织病理诊断包括色素痣35例,基底细胞癌29例,脂溢性角化病15例,鲍恩病7例,甲黑素斑6例,表皮囊肿5例,汗孔瘤、出血及皮肤纤维瘤各4例,其他32例。结论临床部分疾病表现有黑素瘤特征,容易误诊,需掌握其临床特征,积极进行皮肤镜、皮肤组织病理等辅助检查明确诊断,降低误诊率。

Objective To analyze 141 cases clinically misdiagnosed as malignant melanoma,and to improve the understanding and diagnosis of diseases.Methods Totally,141 patients preliminarily diagnosed with melanoma,which was finally excluded according to histopathological examination results,were collected from the pathological database of Department of Dermatology,Xijing Hospital,The Fourth Military Medical University from November 2001 to September 2019,and their clinical and histopathological data were analyzed retrospectively.Results Among the 141 cases clinically misdiagnosed as melanoma,64 were males and 77 were females.Their median age at the time of misdiagnosis was 51 years,and the average disease duration was 103.4 months.The patients mainly presented with patches and papules,most of which were black in color.Based on histopathological manifestations,35 patients were diagnosed with pigmented nevi,29 with basal cell carcinoma,15 with seborrheic keratosis,7 with Bowen′s disease,6 with nail melanin spots,5 with epidermal cysts,4 with poroma,4 with hemorrhage,4 with dermatofibroma,and 23 with other skin diseases.Conclusions In clinical practice,some diseases with characteristics of melanoma are liable to be misdiagnosed.It is necessary to grasp their clinical features and actively carry out auxiliary examinations such as dermoscopy and histopathological examinations to confirm the diagnosis and reduce the misdiagnosis rate.